Confidential Telephone Reference Check Form

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GREAT NECK PUBLIC SCHOOLS
Human Resources Department
CONFIDENTIAL TELEPHONE REFERENCE CHECK
Directions: Please complete the form and document any responses relevant for the candidate. All information received should be treated
with strict confidence. The completed form should be maintained in the candidate’s application folder.
Name of Applicant: _____________________________________________________________
Date: __________________________
P
A
F
:
OSITION
PPLIED
OR
Teacher/Psy/Soc Wkr/Guidance
Administrative/Supervisory
Bus Driver
Other
Substitute Teacher
Clerical
Custodial/Cleaner
______________________
Teacher Assistant
Consultant
Food Service
______________________
School Monitor/Teacher Aide
Student Worker
Groundskeeper
______________________
For any item relevant to this candidate, place a (  ) in the appropriate column. It is not necessary to ask about all items.
I
A
S
O*
I
A
S
O*
Integrity
Quality of Work
Cooperation
Technical Skills
Enthusiasm
Relationships w/People
Self-Control/Poise
Communication Skills
Values/Principles
Attendance/Punctuality
Sense of Humor
Goals/Aspirations
Initiative
*I = Inadequate
A = Adequate
S = Strong
O = Outstanding
To your knowledge, is there anything regarding the candidate’s background which would be of concern relative to their integrity, moral
character, or the like?
Yes
No
__________________________________________________________________
If response is “yes,” please get explanation:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Please offer any additional information/comments that would assist us in evaluating this candidate:
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
I
:
NFORMATION REGARDING REFERENCE
__________________________________________________________________
Relationship to candidate (e.g., supervisor, co-worker, etc):
Reference Name: _____________________________________________________________
Title: _______________________________________
Reference Employer: __________________________________________________________
Phone #: ____________________________________
Reference Obtained by: ____________________________________________________
_____________________________________________
Sign Name
Print Name
091305

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